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<title>送iphone5,送爱疯,就参加白元送爱疯活动|白元家庭倾情奉送</title>
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                    <p>只要回答问题就能获得现在最热门的iphone5!抽选机会每月都有，最多可达三次！只要参与答题并完成简单的问卷，谁都可以参加哦！</p>
                    <p>【大奖】</p>
                    <p>①特别奖：iPHONE５　每个月5人　共计15人</p>
                    <p>【产品奖品】</p>
                    <p>②白元奖：双重机会！除了iphone5，</p>
                    <p>每月还有88名用户有机会获得度过严寒的必需品即热帖10袋！</p>
                    <br>
                    <p>【活动时间】：2012年11月10日～2013年2月9日</p>
                    <p>【参加方法】：回答当月的问题并完成简单的问卷，大家都可以轻松参与。</p>
                    <p class="img"><img src="images/st-2-txt_pic.png" /></p>
                    <p>【参加条件】每个月都会更换问题。每月每人只能参加一次。三个月活动期间内最多可以参加三次！</p>
                    
                    
                    <p>【中奖者发表及奖品寄送】</p>
                    <p>当月的中奖者会在次月中旬左右，在白元的官方微博及官方网站进行公布。根据iphone5在中国大陆地区上市日期所限，可能会推迟奖品寄送，尽请谅解。</p>
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            <form id="form"  onsubmit="return false;">
                <p class="title">【参加时需要输入的项目】</p>
                <div class="clearfix" style="padding:0 30px 0 0;">
                    <p class="part part-1"><span class="list-type"></span><span>姓名</span><input type="text" name="name"></p>
                    <p class="part part-2"><span class="list-type"></span><span>电话号码</span><input type="text" name="phone"></p>
                    <p class="part part-3"><span class="list-type"></span><span>性别</span><input type="radio" name="sex" value="男">男<input type="radio" name="sex" value="女">女</p>
                    <p class="part part-4"><span class="list-type"></span><span>微博账号</span><input type="text" name="weibo_user"></p>
                </div>
                <p class="part part-5"><span class="list-type"></span><span>昵称</span><input type="text" name="nickname"><span class="tip">*没有微博账号的用户请在此处填写</span></p>
                <p class="part part-6"><span class="list-type"></span><span class="name">住所</span><select name="province"><option value="0">请选择</option></select><select name="city"><option value="0">请选择</option></select></p>
                <p class="part add"><span class="list-type"></span><span class="name">地址</span><input class="input-1" type="text" name="address"></p>
                <p class="part part-7">
                    <span class="list-type"></span><span class="name">年龄</span>
                    <input name="age" id="age1" class="radio" type="radio" value="10岁及以下"><label for="age1">10岁及以下</label>
                    <input name="age" id="age2" class="radio" type="radio" value="11~20岁"><label for="age2">11~20岁</label>
                    <input name="age" id="age3" class="radio" type="radio" value="21~30岁"><label for="age3">21~30岁</label>
                    <input name="age" id="age4" class="radio" type="radio" value="31~40岁"><label for="age4">31~40岁</label>
                    <input name="age" id="age5" class="radio" type="radio" value="41~50岁"><label for="age5">41~50岁</label>
                    <input name="age" id="age6" class="radio" type="radio" value="51~60岁"><label for="age6">51~60岁</label>
                    <input name="age" id="age7" class="radio" type="radio" value="61~70岁"><label for="age7">61~70岁</label>
                </p>
                <p class="part part-8">
                    <span class="list-type"></span><span class="name">职业</span>
                    <input name="job" id="job1" class="radio" type="radio" value="学生"><label for="job1">学生</label>
                    <input name="job" id="job2" class="radio" type="radio" value="主妇"><label for="job2">主妇</label>
                    <input name="job" id="job3" class="radio" type="radio" value="公司职员"><label for="job3">公司职员</label>
                    <input name="job" id="job4" class="radio" type="radio" value="公务员"><label for="job4">公务员</label>
                    <input name="job" id="job5" class="radio" type="radio" value="公司经营者"><label for="job5">公司经营者</label>
                    <input name="job" id="job6" class="radio" type="radio" value="其他"><label for="job6">其他</label>
                </p>
                <div class="part-9">
                    <p>※公布中奖者时，会将其微博账号或者昵称公布于众。</p>
                    <p>※因为参加问卷活动所产生的流量费用由您自己承担。</p>
                    <p>※白元旗下员工与相关人员不得参加。</p>
                    <p>※对于必填项目，如有漏写，虚假填写的情况，此次问卷填写视为无效。</p>
                    <p>此外，由于中奖者的地址，联系方式不明等理由联系不上的情况，也有可能取消获奖资格。</p>
                </div>
                <p class="title">【问卷内容】为了改善产品及服务进行参考，希望毫无保留的表达您的意见。</p>
                <div class="part-10 qa">
                    <p class="q">Q1：您是从何处得知本次活动的？</p>
                    <input name="a1" id="a1-1" class="radio" type="radio" value="白元的天猫店铺"><label for="a1-1">白元的天猫店铺</label>
                    <input name="a1" id="a2-1" class="radio" type="radio" value="白元的官方网站"><label for="a2-1">白元的官方网站</label>
                    <input name="a1" id="a3-1" class="radio" type="radio" value="派送的白元镜片屏幕清洁纸包装上"><label for="a3-1">派送的白元镜片屏幕清洁纸包装上</label>
                    <input name="a1" id="a4-1" class="radio" type="radio" value="微博"><label for="a4-1">微博</label>
                    <input name="a1" id="a5-1" class="radio" type="radio" value="百度或者谷歌搜索"><label for="a5-1">百度或者谷歌搜索</label>
                    <input name="a1" id="a6-1" class="radio" type="radio" value="亲朋的介绍"><label for="a6-1">亲朋的介绍</label>
                    <input name="a1" id="a7-1" class="radio" type="radio" value="其他"><label for="a7-1">其他</label>
                </div>
                
                <div class="part-11 qa">
                    <p class="q">Q2：今后如果还有活动的话，您希望得到什么样的奖品？</p>
                    <input name="a2" id="a1-2" class="radio" type="radio" value="照相机"><label for="a1-2">照相机</label>
                    <input name="a2" id="a2-2" class="radio" type="radio" value="拍立得相机"><label for="a2-2">拍立得相机</label>
                    <input name="a2" id="a3-2" class="radio" type="radio" value="平板电脑（iPad等）"><label for="a3-2">平板电脑（iPad等）</label>
                    <input name="a2" id="a4-2" class="radio" type="radio" value="旅游券"><label for="a4-2">旅游券</label>
                    <input name="a2" id="a5-2" class="radio" type="radio" value="智能手机"><label for="a5-2">智能手机</label>
                    <input name="a2" id="a6-2" class="radio" type="radio" value="其他"><label for="a6-2">其他</label>
                </div>
                
                <div class="part-12 qa">
                    <p class="q">Q3：今后您希望白元能够出售何种商品？</p>
                    <input name="a3" id="a1-3" class="radio" type="radio" value="浴盐"><label for="a1-3">浴盐</label>
                    <input name="a3" id="a2-3" class="radio" type="radio" value="冰枕"><label for="a2-3">冰枕</label>
                    <input name="a3" id="a3-3" class="radio" type="radio" value="专用口罩（防尘，防花粉等效果佳）"><label for="a3-3">专用口罩（防尘，防花粉等效果佳）</label>
                    <input name="a3" id="a4-3" class="radio" type="radio" value="清洁用品"><label for="a4-3">清洁用品</label>
                    <input name="a3" id="a5-3" class="radio" type="radio" value="芳香防蛀剂"><label for="a5-3">芳香防蛀剂</label>
                    <input name="a3" id="a6-3" class="radio" type="radio" value="芳香除湿剂"><label for="a6-3">芳香除湿剂</label>
                    <input name="a3" id="a7-3" class="radio" type="radio" value="其他"><label for="a7-3">其他</label>
                    <input name="a3" id="a8-3" class="radio" type="radio" value="没有特别的"><label for="a8-3">没有特别的</label>
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                <div class="part-13 qa">
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